Exam 2: Txtbook question
A nurse is providing care for a patient newly diagnosed with heart disease. Which dietary, activity, or lifestyle modification(s) should be included in the plan of care? (Select all that apply.) A. Stopping smoking B. Drinking lots of water C. Limiting sedentary lifestyle D. Eating a diet rich in red meat and protein E. Limiting alcohol intake
A. Stopping smoking C. Limiting sedentary lifestyle E. Limiting alcohol intake
The nurse is screening patients for their risk of developing heart disease. The nurse should consider which patient at greatest risk? A. A 60-year-old obese male smoker with a family history of heart disease B. A 40-year-old female who drinks two glasses of wine every day C. A 70-year-old male smoker with a long-standing history of hypertension D. A 50-year-old female smoker with a family history of heart disease
A. A 60-year-old obese male smoker with a family history of heart disease
What information should be included in the teaching plan for Mr. Smith? (Select all that apply.) A. Check your BP frequently. B. Start running as an exercise program immediately. C. A diet limiting carbohydrates in favor of fats and proteins is advisable. D. If you must drink, limit it to one drink per day. E. If you must drink, beer is better than wine.
A. Check your BP frequently. D. If you must drink, limit it to one drink per day.
What is the most likely procedure to determine the cause of severe chest pain in the patient newly admitted to the hospital? A. Coronary angiography B. Nuclear stress testing C. Right heart catheterization D. TEE
A. Coronary angiography
Which instructions are appropriate for Mr. Smith? A. Lose weight, exercise, and limit alcohol intake. B. Prepare for coronary angiography. C. Schedule an ambulatory ECG. D. Plan for a TEE.
A. Lose weight, exercise, and limit alcohol intake.
Mr. Smith's BP increases his risk of heart disease through what action(s)? (Select all that apply.) A. Prolonged increased afterload B. Prolonged increased stress on vasculature C. Increased cardiac workload D. Increased automaticity E. Decreased contractility
A. Prolonged increased afterload B. Prolonged increased stress on vasculature C. Increased cardiac workload
The nurse has just received a report on assigned patients. Which of the following patients should be assessed first? A. The patient with indigestion and increased troponin levels B. The patient with indigestion and increased CK levels C. The patient admitted 2 days ago with a BNP of 75 pg/mL D. The patient admitted 2 days ago with increased LDLs and C-reactive protein
A. The patient with indigestion and increased troponin levels
What are Mr. Smith's modifiable risk factors? (Select all that apply.) A. Weight B. Family history of heart disease C. Dietary patterns D. Drinking history E. Homocysteine levels
A. Weight C. Dietary patterns D. Drinking history
The nurse is educating a group of teens about the prevention of cardiovascular disease. Which risk factor is not preventable? Age Obesity Hypertension Hyperlipidemia
Age
The nurse assesses a patient's blood pressure when lying and sitting, noting a significant drop in the blood pressure with the position change. What priority assessment should the nurse make next? Ask if the patient is dizzy. Auscultate the lungs. Determine the radial pulse. Ask if the patient is short of breath.
Ask if the patient is dizzy.
______ is the major cause of CAD and is characterized by a focal deposit of cholesterol and _______, primarily within the intimal wall of the artery Group of answer choices Hypertension, plaque Atherosclerosis, lipids Diabetes, lipids Diabetes, clots
Atherosclerosis, lipids
Which statements about the heart are correct? Select all that apply. The capillary bed consists of the delivery of waste and the removal of nutrients to the heart. The atrioventricular valves are between the lungs and the heart. Atrial contraction takes place immediately after depolarization. Cardiac output consists of heart rate, preload, afterload, and contractility. Atrial kick occurs in 30% of the population.
Atrial contraction takes place immediately after depolarization. The capillary bed consists of the delivery of waste and the removal of nutrients to the heart.
What laboratory values are significant indicators of acute heart injury? A. Increased CK and myoglobin B. Increased CK-MB and troponin C. Decreased BNP and platelets D. Increased CK with low levels of CK-MB
B. Increased CK-MB and troponin
A patient with hypertension has which physical symptom? A. Decreased resistance, which may increase CO B. Increased resistance, which may decrease CO C. Increased resistance, which may increase CO D. Decreased resistance, which may decrease CO
B. Increased resistance, which may decrease CO
The nurse anticipates what procedure for the patient at risk for stroke because of the potential presence of blood clots in the right atrium? A. Nuclear stress test B. TEE C. Coronary angiography D. CXR
B. TEE
What are medication treatment strategies for valvular heart disease (select all that apply)? Group of answer choices Beta blockers Diuretics for edema and shortness of breath management Balloon angioplasty Heart transplant Home EKG
Beta blockers Diuretics for edema and shortness of breath managemen
What is an important nursing action following a cardiac catheterization intervention? A. Early mobilization to prevent clot formation B. Fluid restriction to avoid fluid overload C. Bedrest to avoid stress on cannula insertion site D. Head of bed at 30 degrees for respiratory support
C. Bedrest to avoid stress on cannula insertion site
Altered levels of sodium, potassium, and calcium may result in what condition? A. Fluid loss B. Fluid retention C. Dysrhythmias D. Shortness of breath
C. Dysrhythmias
Which is true of the electrical conduction system of the heart? A. It is primarily controlled by the movement of uncharged ions. B. It has a positive resting membrane potential. C. It is reflected in the waveforms on the electrocardiogram. D. It requires cells that respond only to a stimulus from the autonomic nervous system.
C. It is reflected in the waveforms on the electrocardiogram.
What information should be included in the teaching plan for a 76-year-old patient after a physical? A. Initiating a new strenuous exercise regimen is recommended. B. Limit physical activity and exercise. C. Report any new or excessive fatigue. D. Excessive fatigue is not unusual as you age.
C. Report any new or excessive fatigue.
Which factors most influence blood pressure? Select all that apply. Cardiac output Preload Peripheral vascular resistance Afterload Contractility
Cardiac output Peripheral vascular resistance Afterload Contractility
Which symptom indicates poor perfusion? Select all that apply. Cool skin temperature Cyanosis Blood pressure of 120/80 mm Hg Nonpalpable pulses Muscular build
Cool skin temperature Cyanosis Nonpalpable pulses
What statement indicates further teaching is necessary? A. "My family history makes me worry." B. "Changing my eating habits is hard." C. "I will talk with my doctor before starting an exercise program." D. "My blood pressure is not so high."
D. "My blood pressure is not so high."
Which factor is a modifiable risk factor for heart disease? Age Family history Ethnic background Diet
Diet
The nurse is preparing to assist with a chemical stress test for an immobile patient. Which medication should the nurse prepare for administration? Aspirin Metoprolol Dobutamine Nitroglycerin
Dobutamine
Which diagnostic tests should the nurse anticipate will be ordered for the client with a cardiac condition? Select all that apply. Computed tomography scan Electrocardiography Stress test Echocardiogram Barium swallow
Electrocardiography Stress test Echocardiogram
What is the composition of the heart? A. Four chambers with four valves that control flow through the heart and lungs through changes in pressure B. Four chambers and four valves that control flow through the heart and lungs through changes in oxygen levels C. Two chambers on the right receiving blood from the high-pressure venous system and two chambers on the left sending blood into the low-pressure arterial system D. Two chambers on the right receiving oxygenated blood from the venous system and two chambers on the left receiving deoxygenated blood from the pulmonary circuit
Four chambers with four valves that control flow through the heart and lungs through changes in pressure
The nurse suspects pericarditis in a patient who reports chest pain. Which type of sound is heard on auscultation? Click Friction rub Gallop Turbulent flow
Friction rub
The nurse is performing an assessment on a patient who had severe blood loss during a surgical procedure. Which assessment finding indicates a decrease in preload? Increased pulse rate Increased blood pressure Presence of peripheral edema Presence of crackle sounds on auscultation
Increased pulse rate
Mr. Harry and his caregiver are trying to decide if they should call their provider about worsening heart failure symptoms. Which of the following is the most important to report? Group of answer choices - Increased lower extremity edema - Increased abdominal bloating - Weight gain of >5 lbs in a week - Increased shortness of breath and reduced exercise tolerance
Increased shortness of breath and reduced exercise tolerance
The nurse understands the following about jugular venous distention (JVD) Group of answer choices - JVD is best assessed standing up - JVD is a sensitive and specific sign of hypertrophic cardiomyopathy - JVD is an indication of liver congestion which may be related to heart failure - JVD is an indication that heart failure is not acute and no medications are required
JVD is an indication of liver congestion which may be related to heart failure
What factor increases blood volume when the blood pressure is low? Heart rate increases Kidneys release renin Cardiac output increases Body retains aldosterone
Kidneys release renin
The nurse is discussing a patient's cardiac catherization results. The patient asks what it means to have a blockage in the "LAD" branch of the coronary arteries. Which statements by the nurse are correct? Select all that apply. LAD stands for left anterior descending. The LAD delivers blood to the left side of the heart. The LAD branches off of the left main coronary artery. The LAD delivers blood to the right atrium. The posterior interventricular branch comes off of the LAD.
LAD stands for left anterior descending. The LAD branches off of the left main coronary artery.
A patient has a known aortic stenosis and left sided hypertrophy, which leads the nurse to expect which finding from diagnostics and/or assessment (Select all that apply): Group of answer choices - Loud murmur at the 2nd intercostal space on the upper right chest, close to the sternal border - A normal heart silhouette on chest xray, with the heart taking up <50% of the chest cavity - Crackles on auscultation of lower lungs - Clubbed fingers and 1:2 anterioposterior diameter - An enlarged heart silhouette on chest xray, with the heart taking up >50% of the chest cavity
Loud murmur at the 2nd intercostal space on the upper right chest, close to the sternal border Crackles on auscultation of lower lungs An enlarged heart silhouette on chest xray, with the heart taking up >50% of the chest cavity
The nurse is evaluating an older adult for symptoms of cardiovascular problems. Which symptoms are most concerning? Select all that apply. Mental status changes Agitation Frequent falls Changes in gastrointestinal (GI) function Impaired kidney function
Mental status changes Agitation Frequent falls Impaired kidney function
The nurse receives hand-off report on each of these patients. Which one should the nurse see first? Patient 1 hour after returning from a cardiac catherization, right groin dressing intact with dime-sized area of blood, distal pulses intact. Patient with an elevated troponin and creatine kinase-myocardial band (CK-MB), chest pain of 3 on a 1 to 10 scale. Patient with crackles bilaterally in the bases, oxygen saturation 94% on 2 L per nasal cannula, brain natriuretic peptide (BNP) elevated. Patient going for an exercise stress test in 2 hours and needs teaching.
Patient with an elevated troponin and creatine kinase-myocardial band (CK-MB), chest pain of 3 on a 1 to 10 scale.
What type of angina occurs at rest, may occur in absence of CAD, seen in patients with history of migraine headaches and Raynaud's phenomenon, manifests as chest pain and marked transient ST-segment elevation Group of answer choices Unstable angina Prinzmental's angina Stable angina Angina pectoris
Prinzmental's angina
The nurse is making patient assignments for the shift. Which patient is best to delegate to the licensed practical nurse (LPN)? Patient 1 hour after returning from a cardiac catherization, right groin dressing intact with dime sized area of blood, distal pulses intact. Patient with an elevated troponin and CK-MB, chest pain of 3 on a 1 to 10 scale. Patient with crackles bilaterally in the bases, oxygen saturation 94% on 2 L per nasal cannula, BNP elevated. Patient going for an exercise stress test in 2 hours and needs teaching.
Patient with crackles bilaterally in the bases, oxygen saturation 94% on 2 L per nasal cannula, BNP elevated.
Which assessment finding demonstrates adequate perfusion? Pink skin and nailbeds Blood pressure 85/53 Pulse oximetry of 89% Cool extremities
Pink skin and nailbeds
The nurse is performing a visual assessment on a client that is having chest pain. Which findings are most concerning? Select all that apply. Restlessness Diaphoresis Grimacing Shortness of breath Edema
Restlessness Diaphoresis Shortness of breath Edema
The nurse is auscultating the heart tones of a client. What sounds are considered normal? Select all that apply. S1 S2 S3 S4 Murmur
S1 S2
The nurse is preparing a patient for a coronary angiography. Which laboratory report is most concerning and should be reported to the provider? Hemoglobin of 13.6 g/dL Serum creatinine of 2.3 mg/dL C-reactive protein 0.9 mg/L Triglycerides of 254 mg/dL
Serum creatinine of 2.3 mg/dL
The Frank Starling Law tells us that as blood volume increases (preload), so should the stroke volume and cardiac output when everything else is constant. But in decompensated heart failure with dilated cardiomyopathy Group of answer choices - The left ventricle is overstretched and muscle cannot stretch further and cannot respond to the preload - The left ventricle does not move and cannot respond to the preload - The left ventricle is larger and stronger allowing greater fill and stroke volume - The left ventricle is larger and decreases the afterload
The left ventricle is overstretched and muscle cannot stretch further and cannot respond to the preload
A patient with advanced heart failure has a low ejection fraction and low blood pressure is admitted for telemetry monitoring. The nurse is aware that: Group of answer choices - They should hold the beta blocker because of the low blood pressure - They should call the provider every time the systolic blood pressure is less than 90. - They should monitor blood pressure after Lasix, and watch for changes in mental status - They should not wake up the patient because they are very sleepy.
They should monitor blood pressure after Lasix, and watch for changes in mental status
The nurse is assessing a patient who is experiencing chest pain. Which laboratory result may differentiate between myocardial injury and another cause? Troponin 1 ng/mL C-reactive protein 10 mg/L Serum magnesium 1 mmol/L Glycated hemoglobin (HbA1C) 7%
Troponin 1 ng/mL
Dobutamine stress testing uses a _______ to ______ the heart rate Group of answer choices Chronotrope, increase Dromotrope, decrease lonotrope, increase Chronotrope, decrease
lonotrope, increase
While auscultating a patient's heart sounds, the nurse hears turbulent flow type sounds. Which is the most likely cause of this sound? Closure of the atrioventricular (AV) valves Closure of the semilunar valves Mitral valve stenosis Murmur
murmur